Breast-feeding is the natural process of feeding an infant human milk directly from the breast.

Breast milk feeding is the process of feeding a child human milk that has been expressed either by hand or by pump.

The American Academy of Pediatrics (AAP), the American Academy of Family Physicians, and other medical organizations recommend exclusive breast-feeding for approximately the 1st 6 months of life and support for breast-feeding for the 1st year and beyond as long as mutually desired by mother and child (1).

Description

Maternal benefits (as compared to mothers who do not breast-feed) include: (2)

Decreased postpartum bleeding (due to oxytocin release)

Decreased risk of postpartum depression

Easier postpartum weight loss

Delayed postpartum fertility

Decreased risk of breast and ovarian cancer

Decreased risk of type 2 diabetes

Increased sense of well-being (endorphin response)

Increased bonding

Convenience

Cost

Infant benefits (as compared with children who are formula-fed) include: (2)

Initiate breast-feeding immediately after birth, ideally placing the infant at the mother’s breast in the delivery room.

Get mother in a comfortable position, usually sitting or reclining with the baby’s head in crook of her arm.

Side-lying position often useful following cesarean-section delivery.

Bring baby to mother to decrease stress on mother’s back.

Baby’s belly and mother’s belly should face each other or touch (“belly to belly”). Initiate the rooting reflex by tickling baby’s lips with nipple or finger. As baby’s mouth opens wide, mother guides her nipple to back of her baby’s mouth while pulling the baby closer. This will ensure that the baby’s gums are sucking on the areola, not the nipple (6)[C].

Feed every 2–4 hours, 20 minutes per side.

Rooming-in to encourage on-demand feeding (6)

Observation of a nursing session by an experienced physician, nurse, or lactation consultant

Avoid supplementation with formula or water.

Review expectations, techniques, and feeding cues.

Be very encouraging.

Ongoing Care

Follow-Up Recommendations

See mother and baby within a few days of hospital discharge.

Primary care-initiated interventions to promote breast-feeding have been shown to be successful with respect to child and maternal health outcomes.

Patient Monitoring

Monitor infant’s weight and output closely.

Supplementation with infant formula recommended only if infant has lost 7% or more of birth weight, shows signs of dehydration such as decreased urine output, or has less than 3 small stools a day.

Given that the mechanism of milk production is supply and demand, supplementation without persistent and regular breast stimulation with frequent feedings or breast pump use will decrease milk production and decrease breast-feeding success.

Alcohol should be avoided. 1–2 drinks/week of alcohol may be okay, but mothers should avoid nursing 2–3 hours after a drink. Only <2% of alcohol is passed to baby via breast milk.

For infants:

In 2008, the AAP increased its recommended daily intake of vitamin D in infants to 400 IU. For exclusively breast-fed babies, this will require taking a vitamin supplement such as Poly-Vi-Sol or Vi-Daylin vitamin drops, 0.5 cc/day, beginning at 2 months of age.

In 2010, the AAP recommended adding supplementation for breast-fed infants with oral iron 1 mg/kg per day beginning at age 4 months (7).

Preterm infants fed human milk should receive an iron supplement of 2 mg/kg per day by 1 month of age, and this should be continued until the infant is weaned to iron-fortified formula or begins eating complementary foods that supply the 2 mg/kg of iron.

Growth spurts: Anticipate these ∼10 days, 6 weeks, 3 months, and 4–6 months. Baby will nurse more often at these times for several days. This will increase milk production to allow for further adequate growth.

The AAP recommends supplementation with vitamin D starting at age 2 months and iron starting at age 4 months (7,9).

Weaning:

Exclusive breast milk is optimal food for 1st 6 months.

Solid food may be introduced at 6 months.

For mothers going to work, start switching the baby to breast milk feeding or formula feeding during the hours mother will be gone about a week ahead of time. Do this by dropping a feeding every few days and substituting pumped breast milk or formula, preferably given by another caregiver.

Family planning:

Lactational amenorrhea method (LAM): Breast-feeding may be used as effective birth control option if (1) infant is less than 6 months old, (2) infant is exclusively breast-feeding, and (3) mother is amenorrheic (10).

Most providers use progesterone-only birth control pills in the early postpartum period.

The Academy of Breastfeeding Medicine (ABM), a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation. www.bfmed.org

La Leche League at www.llli.org

Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services, a joint WHO/UNICEF statement published by the World Health Organization. http://www.unicef.org/newsline/tenstps.htm

Check for signs of thrush in baby and on mother’s nipple. If affected, treat both.

Engorgement:

Usually develops after milk 1st comes in (day 3 or 4)

Signs are warm, hard, sore breasts.

To resolve, offer baby more frequent nursing

May have to hand express a little milk to soften areola enough to let baby latch on.

Breast-feed long enough to empty breasts.

Generally resolves within a day or 2.

References

1. http://www.aap.org/advocacy/releases/feb05breastfeeding.htm

2. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries [Structured Abstract]. Rockville, MD: Agency for Healthcare Research and Quality, 2007. Available at: http://www.ahrq.gov/clinic/tp/brfouttp.htm.

4. U.S. Department of Health and Human Services. Healthy People 2010, Conference ed. Vols I and II. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, January 2000.

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